Version July 2025
| Absolute contraindications |
| History of any intracranial hemorrhage |
| History of ischemic stroke within the preceding 3 months, with the important exception of acute ischemic stroke seen within 3 hours, which may be treated with thrombolytic therapy |
| Presence of a cerebral vascular malformation or a primary or metastatic intracranial malignancy |
| Symptoms or signs suggestive of an aortic dissection |
| A bleeding diathesis or active bleeding, with the exception of menses; thrombolytic therapy may increase the risk of moderate bleeding, which is offset by the benefits of thrombolysis |
| Significant closed-head or facial trauma within the preceding 3 months |
| Relative contraindications |
| History of chronic, severe, poorly controlled hypertension or uncontrolled hypertension at presentation (eg, blood pressure >180 mmHg systolic and/or >110 mmHg diastolic; severe hypertension at presentation can be an absolute contraindication in patients at low risk) |
| History of ischemic stroke more than 3 months previously |
| Dementia |
| Any known intracranial disease that is not an absolute contraindication |
| Traumatic or prolonged (>10 min) cardiopulmonary resuscitation |
| Major surgery within the preceding 3 weeks |
| Internal bleeding within the preceding 2 to 4 weeks or an active peptic ulcer |
| Noncompressible vascular punctures |
| Pregnancy |
| Current warfarin therapy; the risk of bleeding increases as the INR increases |
| For streptokinase or anistreplase, a prior exposure (more than 5 days previously) or allergic reaction to these drugs |
INR: international normalized ratio.
* May not be all-inclusive or definitive.